Reflections on 40 years as a doctor in Women's Health

Tag Archives: Astrid Lindgren Children’s Hospital

War has so many faces and wears so many different clothes that you might be forgiven for misunderstanding its refugees. Confusing cause and effect in their behaviour, their appearance, and perhaps, most obviously, in their adaptations to the stress of upheaval and migration. There is no universal pattern that obtains, and few things to offer as a template for relief except, perhaps, a welcoming succour. And when numbers become overwhelming, even compassion is strained in the melange of personalities and temperaments that inevitably occur in those fleeing danger. Not all victims may be to our liking, and when resources become limited and privileges are necessarily constrained, the reactions can be unpredictable on both sides. Empathy can mutate into grudging tolerance. Forbearance. Endurance.

But think of the effects on the refugees, first forced to flee intolerable conditions, often leaving behind members of their families, then subject to the hardships and exploitation of the journey, finally being forced to trust themselves to the charity of strangers. It cannot be easy for adults to have their identity subsumed by that of victim, and everything they were, everything they had, everything for which they had worked no longer possible. No longer recognized, let alone appreciated, in a strange land with often stranger customs and language.

And what must it be like for their children who haven’t yet learned the curse of humiliation, or understood what the theft of identity may mean to their parents. They’re caught in the middle ground between witness and casualty, understanding neither. Lacking the tools to navigate the waters, some, I suppose, internalize it; others lash out. But none escape entirely.

I came across an unusual manifestation of trauma that seems unique to Sweden (so far), for some reason –the newly coined Resignation Syndrome: http://www.bbc.com/news/magazine-41748485 ‘[…] it affects only the children of asylum-seekers, who withdraw completely, ceasing to walk or talk, or open their eyes.’

‘The health professionals who treat these children agree that trauma is what has caused them to withdraw from the world. The children who are most vulnerable are those who have witnessed extreme violence – often against their parents – or whose families have fled a deeply insecure environment.’

‘As more Swedes began to worry about the consequences of immigration, these “apathetic children”, as they were known, became a huge political issue. There were reports the children were faking it, and that parents were poisoning their offspring to secure residence. None of those stories were proven.’ A not so hidden ‘blame the victim’ scenario that tends to surface under conditions of societal stress.

‘Numerous conditions resembling Resignation Syndrome have been reported before – among Nazi concentration camp inmates, for example. In the UK, a similar condition – Pervasive Refusal Syndrome – was identified in children in the early 1990s, but there have been only a tiny handful of cases, and none of them among asylum seekers. The most plausible explanation is that there are some sort of socio-cultural factors that are necessary in order for this condition to develop. A certain way of reacting or responding to traumatic events seems to be legitimised in a certain context’ writes Dr Karl Sallin, a paediatrician at the Astrid Lindgren Children’s Hospital, part of Karolinska University Hospital in Stockholm.

Theories abound, of course. There is a view ‘commonly held among doctors treating children with Resignation Syndrome, that recovery depends on them feeling secure and that it is a permanent residence permit that kick-starts that process.’ Unfortunately, with increasing numbers of refugees arriving, both the patience and the available resources are wearing thin, so stricter adherence to admission criteria do not always allow a family to stay. ‘Last year, a new temporary law came into force that limits all asylum seekers’ chances of being granted permanent residence. Applicants are granted either a three-year or 13-month visa.’

One treatment seems to be having some success, even with those not granted permanent visas, however. The thesis is that sickness has to do with former trauma, not asylum. ‘When children witness violence or threats against a parent, their most significant connection in the world is ripped apart’ –the very connection on which the child has been dependent. ‘That family connection must be re-built, but first the child must begin to recover, so Solsidan’s [the treatment center’s] first step is to separate the children from their parents. “We keep the family informed about their progress, but we don’t let them talk because the child must depend on our staff. Once we have separated the child, it takes only a few days, until we see the first signs that, yes, she’s still there…” says Annica Carlshamre, a senior social worker for Gryning Health, a company that runs Solsidan, a home for all kinds of troubled children.

Even if effective, I would imagine that not every family would be willing to part with their child to strangers, nor would the number of treatment centers be equal to the task. Still, it may be a method worth exploring further.

Post-Traumatic Stress Disorder, Resignation Syndrome, Situational Adjustment Reactions, Panic Attacks… I am not alone in wondering what these may produce in the hundreds of thousands, if not millions, affected –either in childhood when coping mechanisms may not yet have been learned, or worse perhaps, in adulthood when the mechanisms may have been discarded. What can we expect from a generation torn from its customs, and rightful expectations of a peaceful family life? A generation often deprived of education, to say nothing of safety? What is normal to those who have never experienced it? And what are the obligations of the rest of us to them?

War, it is said, will be with us always, but we must not be fooled by its seeming inevitability. I suppose it is unbecomingly naïve in this time of terrorism and bellicose patriotism, but I still remember the words of Martin Luther King, Jr: “Darkness cannot drive out darkness; only light can do that. Hate cannot drive out hate; only love can do that.”

An ounce of prevention is worth a pound of cure? It’s not an answer, perhaps -just a hope…